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Ask L.. FIED PROGRAM CONSOLIDATED FOR:._ �` J U UNDERGROUND STORAGE TANK ( ( / OPERATING PERMIT APPLICATION -TANK INFORMATION (One form per UST) TYPE OF ACTION (Check one item only. For a UST closure or removal,complete only this section and Sections 4 11,111,/V,and IX below) n ��`I ❑ 1.NEW PERMIT ® 3.RENEWAL PERMIT [:15.CHANGE OF INFORMATION ��,/vJ[ ❑ 6.TEMPORARY UST CLOSURE ❑ 7.UST PERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: 430.. DATE EXISTING UST DISCOVERED: 430b. I. FACILITY INFORMATION FACILITY ID#(Agency Use Only) _ _ 1 BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. Marigold Shell BUSINESS SITE ADDRESS 103. CITY 104. 6131 Pacific Avenue I Stockton II. TANK DESCRIPTION TANK ID# LZ X432. TANK MANUFACTURER 433. TANK CONFIGURATION:THIS TANK IS 434. 2 Owens Corning ® 1.A STAND-ALONE TANK Complete one page for each ❑ 2.ONE IN A COMPARTMENTED UNIT compartment in the unit. DATE UST SYSTEM INSTALLED 435. TANK CAPACITY IN GALLONS 436. NUMBER OF COMPARTMENTS IN THE UNIT 437. 12,000 1 III. TANK USE AND CONTENTS TANK USE ® la.MOTOR VEHICLE FUELING ❑ Ib.MARINA FUELING ❑ Ic.AVIATION FUELING 439. ❑ 3.CHEMICAL PRODUCT STORAGE ❑ 4.HAZARDOUS WASTE(includes Used Oil) ❑ 5.EMERGENCY GENERATOR FUEL[HSC§25281.5(c)] _ ❑ 6.OTHER GENERATOR FUEL ❑ 95.UNKNOWN _ ❑ 99.OTHER(Specify): 439x. CONTENTS PETROLEUM: ❑ la.REGULAR UNLEADED ❑ lc.MIDGRADE UNLEADED ® ]b.PREMIUM UNLEADED 440. ❑ 3.DIESEL ❑ 5.JET FUEL ❑ 6.AVIATION GAS -._ ❑ 8.PETROLEUM BLEND ❑ 9.OTHER PETROLEUM(Specify): 440a. - ....... ... _ -- NON-PETROLEUM: ❑ 7.USED OIL ❑ 10.ETHANOL -- ❑ 11.OTHER NON-PETROLEUM(Specify): 440b. IV. TANK CONSTRUCTION TYPE OF TANK _ ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 95.UNKNOWN _ _ _ 443 ..... .................._..-.._...._...._-_.__ .._._......................_.......__.._...._.......__-..__..._...._......._...........................---._..____-._.. PRIMARY CONTAINMENT ❑ 1.STEEL ® 3.FIBERGLASS ❑ 6.INTERNAL BLADDER _-444? ❑ 7.STEEL+INTERNAL LINING ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 444a. SECONDARY CONTAINMENT ❑ 1.STEEL ®3.FIBERGLASS ❑ 6.EXTERIOR MEMBRANE LINER ❑ 7.JACKETED ❑ 90.NONE ❑ 95.UNKNOWN [199.OTHER(Specify): 445a. -- ..__............_.. --.. _.- _.--____............................. -_ --.....- OVERFILL PREVENTION ® 1.AUDIBLE&VISUAL ALARMS ❑ 2.BALL FLOAT ® 3.FILL TUBE SHUT-OFF VALVE 452. ❑ 4 TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION_ _ ❑ 1.SINGLE WALL ® 2.DOUBLE WALL ❑ 99.OTHER __ 460. SYSTEM TYPE ®- L PPRESSURE 0 2.GRAVITY El 3.CONVENTIONAL SUCTION 0 4.SAFE SUCTION[23 CCR§2636(a)(3)] 458. PRIMARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464. ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Specify): 464&. SECONDARY CONTAINMENT ❑ L STEEL ® 4.FIBERGLASS ❑ 8.FLEXIBLE ❑ 10.RIGID PLASTIC 464b. _._....................�_.__._._......._0 90. ONE [1 95.UNKNOWN 0 99.OTHER(S cue ify): 464c. PIPINGITURBINE CONTAINMENT SUMP TYPE ® I.SINGLE WALL ❑ 2.DALEl WL 90.NONE - 464d. VI. VENT,VAPOR RECOVERY (VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTAINMENT El 1.STEEL & 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464et VENT SECONDARY CONTAINMENT ❑ 1.STEEL Q1 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE [199.OTHER(Specify): 46441 -- ..__............... ._..T---..........................._...._._....._.._.._........_.._..._......._..---._......_......._.._.._.._ --- - _�_..._._.... -..._....._.. VR PRIMARY CONTAINMENT ❑ 1.STEEL ® 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 86686 .-.__._._.-. _ _ __._....................._.....--..._-..-..-_.._- .-.-- -- -----......_.......... ..__................._...__ ..._ VR SECONDARY CONTAINMENT ❑ I.STEEL 4.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464h. ----.........................._. __.._......_.._-.._---- -._.............._._. .----- 464hi_ - VENT PIPING TRANSITION SUMP TYPE of 1.SINGLE WALL ❑ 2.DOUBLE WALL )W90.NONE 464t' __ _ ...._.__...._..._ __.._.._._.__.._......._. --.- RISER PRIMARY CONTAINMENT 1.STEEL [:14.FIBERGLASS ❑ 10.RIGID PLASTIC C1464].90.NONE ❑ 99.OTHER(Specify): 464- RISER SECONDARY CONTAINMENT ❑ L STEEL 94.FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 90.NONE ❑ 99.OTHER(Specify): 464kl. ........................................_._........................__......__.___._............_...........,..... -.......__.............................._. _-_ _..._............._............._....-- - .... _ _.........................................__.._.._..._.................__._..._..........___..._ FILL COMPONENTS INSTALLED 1.SPILL BUCKET W3.STRIKER PLATEIBOTTOM PROTECTOR ❑ 4.CONTAINMENT SUMP 45la-c. VII. UNDER DISTPENSER CONTAINMENT (UDC) CONSTRUCTION TYPE-- _ ® 1.SINGLE WALL - - ❑ 2 DOUBLE WALL ❑ 3.NO DISPENSERS - ❑ Od1 469a. ................................................... ....... m 4696. CONSTRUCTION MATERIAL ® 1.STEEL ❑ 4 FIBERGLASS ❑ 10.RIGID PLASTIC ❑ 99.OTHER(Specify) 469c. VIII. CORROSION PROTECTION ' „ STEEL COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) ❑ 4.IMPRESSED CURRENT 6.ISOLATION 448. IX. APPLICANT SIGNATURE CERTIFICATION: I certify that this UST system is compatible with the hazardous substance stored and that the informatiot provided herein is true, accurate,and in full compliance with legal requirements. L) APPLICANT SIGNATURE DATE 8/24/2009 470 APPLICANT NAME(print) Hung Thanh Tran 471. APPLICANT TITLE O er/Operator 472. t ?►1 UPCF UST-B Rev.(12/2007)-1/2 www.unidocs.org